International Journal of Innovative Research and Development

Abstract

Introduction: Delirium tremens is the severe form of alcohol withdrawal state that carries a certain degree of mortality. It is important to understand the contributing factors for the development of this complicated withdrawal state.

Objectives of the Study: is to identify the related risk factors associated with the occurrence of delirium tremens and identify the risk factors predict the occurrence of delirium tremens.

Methodology: This analytical, cross sectional study was carried out to identify the related risk factors associated with the development of delirium tremens (DT) among patients admitted for detoxification treatment of Alcohol dependence syndrome that fulfills ICD-10 diagnostic criteria at MMM De-addiction and research centre, MOSC Medical College Hospital, Kolenchery, Ernakulam dist, Kerala, India.

Results: Among the 104 patients admitted for detoxification treatment during the period of January 2014- June 2014; twenty-three subjects developed delirium tremens among these, 6 subjects developed withdrawal seizures. The factors significantly associated with delirium tremens are increasing age (p=0.001**), previous history of DT (p=0.001**), binge drinking pattern (p=0.001**), increased amount of alcohol consumption (p=0.02*), and delay in hospitalization (p=0.001**), and increased ASI score (severity of addiction) (p=0.001**). The significant predictors of Delirium tremens are binge drinking, alcoholic liver disease, and increased severity of addiction; among these the significant positive predictor of delirium tremens is increased severity of addiction (OR=1.9 p=0.008*)

Conclusion: patient admitted for detoxification should be carefully evaluated for these risk factors; and the vulnerable subjects with the presence of these risk factors should be cautiously managed and carefully monitored by the nurses taking care of these patients to prevent the occurrence of the fatal complication associated with alcohol withdrawal syndrome. Environmental manipulation, close observation and monitoring of vital signs, front loading dose of benzodiazepines are essential for preventing the occurrence of Delirium tremens during detoxification period.

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Abstract

Introduction: Relapse is an inevitable phenomenon that arises in the course of substance use disorder that can be a frustrating experience for patients, caregivers and therapists. Co morbid psychiatric illness makes the individual more vulnerable to relapse. This study analyzed the rates, patterns of relapse and survival time before relapse among subjects with and without co-morbid psychiatric illness over a period of 1year after inpatient de-addiction treatment.

Subjects  and Methods: Prospective cohort, comparative design  in which 104 subjects admitted for 31days treatment programme  for substance use disorder from January to June 2014 at tertiary care hospital in Kerala  were  studied for 1year post treatment period. Subjects were classified into co morbid SUD (n=56) and Non co morbid SUD (n=48) based on the presence of psychiatric illness diagnosed by the treating psychiatrist based on ICD 10 DCR. Relapse status were assessed during monthly follow up meetings, irregular follow-ups were tracked from the OPD record and followed up telephonically.

Results: Present study findings revealed that 53.8% SUD subjects had co morbid Psychiatric illness. More than one third of subjects (39.4%) relapsed within 1year period. At 1year, 43% percentage of subjects in the co-morbid group relapsed their substance use whereas only (29%) in the non co morbid SUD group relapsed their substance use (p=0.04*). Among co morbid subjects 37 % of subjects with bipolar mania, 46%with Depression relapsed at 1year follow up. Kaplan Meir survival analysis revealed that non co morbid SUD had longer survival time compared to co morbid SUD before relapse (p=0.02*).

Conclusion: Strong therapeutic alliance, close monitoring and regular follow up of these subjects with substance use disorder especially with co morbid mental disorders will lower the rates of relapse. 

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